The Rare Presentation of Spontaneous Pneumothorax in a Pediatric Patient

Children presenting to the Emergency Department (ED) with upper respiratory infection (URI) symptoms of unresolved cough are not uncommon. Differentiation of the child's symptoms with thorough history and physical and when appropriate, further evaluation with blood work and imaging is the responsibility of the ED physician. In a clinical environment with increasing ED visits due to nonspecific URIs in children, it is also important not to overutilize an emergent workup with unnecessary testing. Our case involves a patient with atypical symptoms and hopes to highlight the importance of keeping a broad differential for all patients upon initial evaluation. Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient presented with an unresolved cough being treated by an outpatient physician. He had no prior airway disease diagnosis. Severe cough in the absence of prior airway disease is notably less likely, but not an unseen cause of spontaneous pneumothorax. Our patient, however, developed just that. He was officially diagnosed with a right-sided pneumothorax on chest x-ray, underwent supplemental oxygen therapy, and was ultimately transferred to a pediatric hospital for continuation of care. Once there, our patient gradually improved was diagnosed as an asthmatic, and was started on appropriate maintenance medications. It is important to remain vigilant when examining multiple pediatric patients in a shift and to keep in mind that even otherwise healthy pediatric patients are at risk for spontaneous pneumothorax.  Spontaneous pneumothorax is a potentially life-threatening condition. Our five-year-old patient had no prior airway disease diagnosis making spontaneous pneumothorax notably less likely, however, from severe cough our patient developed just that. He was officially diagnosed with right-sided pneumothorax, underwent supplemental oxygen therapy, and was transferred to a pediatric hospital. Once there patient gradually improved, he was diagnosed as an asthmatic and started on appropriate medication to keep his breathing stable. It is essential to keep in mind that even otherwise pediatric patients are at risk for spontaneous pneumothoraxes and we as emergency physicians must keep this in mind during our evaluation.